Many cardiac procedures are commonly performed in the left atrium of the heart, which is not easily accessible. In order to treat the left atrium, a device may enter the patient's circulatory system via the patient's femoral vein. The device then may be advanced through the femoral vein to the right atrium of the heart. Once in the right atrium, a transseptal puncture is typically created in the transseptal wall to gain access to the left side of the heart and associated vasculature.
Although transseptal puncture is commonly performed, life-threatening complications such as pericardial tamponade, aortic perforation, and systemic embolization may occur. Many of these occurrences are the result of unintentional puncturing of the atrial walls. For example, the beating of the heart, slipperiness of the myocardium, and irregularities in the thickness of the septum can contribute to the difficulty in steering a puncturing device, a catheter, or other devices and accurately puncturing the septum without causing injury.
Furthermore, the location of the septal puncture may significantly impact procedural complexity when conducting treatment procedures, such as, for example, cryoablation, pulmonary vein occlusion, left atrial appendage (LAA) closure, transcatheter mitral valve implantation (TMVI), transaortic valve implantation (TAVI), and the like. Due to the extreme manipulations required to attempt concentric positioning of a catheter balloon to one or more pulmonary veins, particularly the right inferior pulmonary vein (RIPV), catheter mechanical robustness has been shown to suffer, resulting in kinking of the guide wire lumen and may also result in leaking of the inner balloon bond. Such failures to achieve an optimal puncture location may negatively impact the ability of physicians to effectively steer such intracardiac medical devices and therefore may negatively impact patient safety and the procedure's efficacy.
In order to locate the precise area of the septal wall to be punctured, the physician may use one or more medical known imaging techniques, such as, for example fluoroscopy, endoscopy, or ultrasound visualization to identify the various anatomical boundaries that form the septum. However, existing techniques for locating an optimal puncture site in the septum wall have drawbacks.
For example, localization of a tip of a puncturing needle can be detected by the surgeon using various anatomical landmarks around the septum. In particular, the septum is comparatively thicker than the fossa ovalis in healthy patients providing an imprecise but potentially important physiological marker. However, in patients with atrial abnormalities, for example a dilated atrium, or as a result of previous surgeries, the traditional markers such as the fossa ovalis may change, making localization difficult and increasing the risk of harm to the patient.
Angiographic techniques have been devised to assist with locating puncture sites. For example, transesophageal and transthoracic echocardiography, intravascular ultrasound, and intracardiac echocardiography have all been employed as a means of determining the optimal transseptal puncture site. Transthoracic ultrasound, however, may not be capable of accurately locating the thin wall of the fossa ovalis and presents difficulties in maintaining both patient comfort and sterility, thus often resulting in an increased cost for a given procedure. Transesophageal echocardiography also presents several disadvantages in some cases, such as limited communication with the patient (resulting from sedation), a risk of esophageal bleeding, longer procedure times, additional cost, and inaccurate identification of the fossa ovalis. In addition, intracardial echocardiography is highly expensive and greatly increases the overall time of the procedure. Also, fluoroscopy imaging techniques require the use of x-rays that are known to be harmful to patients and necessitate physicians wearing heavy lead suits, which can inhibit the physician physically during the procedure, and, over time, may result in ergonomic complications for the physician.
Another problem with existing medical imaging techniques is that they typically involve conventional monitors (e.g., desktop monitors). In other words, during the procedure, the physician is required to look up from the operating table in order to view the images on the monitors. Doing so also requires the physician to look away from the patient and may result in inaccuracies in the procedure due to the physician constantly changing his/her field of view and focus. Some physicians may elect to forego the use of conventional monitors, or may not view the information on the monitors as frequently as they would prefer in order to avoid looking constantly looking away from the patient during the procedure.
Augmented reality devices blend computer-generated information with the user's view of the physical world, i.e., the real world. Stated another way, augmented reality devices augment computer-displayed information to the user's view of the real-world environment in order to enhance situational awareness of the user within the physical world with the computer-displayed information. However, existing augmented reality devices are rather limited in their use and have been primarily limited to personal use, rather than for medical imaging and procedures.
Accordingly, in light of the above limitations, it would be desirable to provide systems, devices, and methods for enhancing cardiac procedure efficacy and safety by using augmented reality devices to improve medical imaging, pre-operative planning, and intra-operative feedback techniques.